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New guidelines issued for treating and identifying high blood pressure in children

New guidelines released Monday may make it easier for healthcare providers to screen and manage high blood pressure in children.

The new clinical practice guidelines, developed by the American Academy of Pediatrics, is the first update on this subject in 13 years and sheds new light on defining normal-range and high blood pressure in children, according to the AAP. A University of Maryland School of Medicine professor was one of the authors.

The guidelines are available online and will be published in the September 2017 issue of Pediatrics. The recommendations explain the connection between hypertension, or abnormally high blood pressure, in children and hypertension in adulthood. It also explains the prevalence of hypertension, often along with two other chronic diseases, among overweight children.

High blood pressure is a leading cause of disease and disability in millions of Americans, according to the pediatrics academy.

Carissa Baker-Smith, an assistant professor of pediatrics at the University of Maryland School of Medicine and a pediatric cardiologist at the University of Maryland Children’s Hospital who helped craft the guidelines, said she hoped they would lead to hypertension being identified earlier in children.

“It is not to be taken lightly that a child has high blood pressure,” said Baker-Smith. “We know they have a greater likelihood of having high blood pressure as an adult and that’s a risk factor for heart disease.”

Unlike adults, ideal blood pressure in children fluctuates as they grow and is different depending on their age, gender, and height. Previous guidelines issued in 2004 by the National Heart, Lung, and Blood Institute included tables outlining ideal blood pressure readings. But they were based on data that included some overweight children, who usually have higher blood pressure, skewing the results.

Tammy Brady, the medical director of the pediatric hypertension program at Johns Hopkins Medicine, said blood pressure readings in children are a “moving target.”

“Imagine you’re in a busy clinic. You get a blood pressure of 116 over 75. Sounds good, but for a 4-year-old it’s super high. Even for an 11-year-old that may be too high,” she said. “It may not be something that pops up on your radar just by eyeballing it.”

Brady praised the new guidelines.

“I think many pediatricians find it difficult to recognize elevated blood pressure so I think making the tables simplified is fantastic,” she said.

The new guidelines use data based only on normal weight children, so the ideal readings are slightly lower.

Baker-Smith, who was on a 20-person committee to develop the guidelines, said they come with new tables that a healthcare provider can print out and put on a wall and refer to. The tables indicate ideal readings for children depending on their gender, height and age.

Untreated hypertension can damage the heart, kidneys, brain and other organs. About 3.5 percent of all children and teenagers have hypertension. Most of those children are overweight.

The prevalence of hypertension in children has been rising since 1988, though it has plateaued in recent years, according to the report.

The guidelines recommend pediatricians take routine blood pressure measurements only at annual preventative care visits because they are more likely to be indicative of a child’s actual blood pressure than those taken during a sick visit. They also recommend starting blood pressure lowering medications after lifestyle interventions have not worked, or if the child has another condition such as diabetes. Pediatricians should recommend lifestyle changes first, the new guidelines say.

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